Document Detail


Intrapartum temperature elevation, epidural use, and adverse outcome in term infants.
MedLine Citation:
PMID:  22291120     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation.
METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders.
RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores <7, and early-onset seizures. In regression analyses, infants born to women with fever >101°F had a two- to sixfold increased risk of all adverse outcomes examined.
CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied.
Authors:
Elizabeth A Greenwell; Grace Wyshak; Steven A Ringer; Lise C Johnson; Michael J Rivkin; Ellice Lieberman
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-01-30
Journal Detail:
Title:  Pediatrics     Volume:  129     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-03     Completed Date:  2012-03-27     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e447-54     Citation Subset:  AIM; IM    
Affiliation:
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA. greenwell.ea@comcast.net
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MeSH Terms
Descriptor/Qualifier:
Analgesia, Epidural / adverse effects*
Analgesia, Obstetrical / adverse effects*
Apgar Score*
Asphyxia Neonatorum / diagnosis,  etiology
Case-Control Studies
Cerebral Infarction / diagnosis,  etiology
Cohort Studies
Electroencephalography
Epilepsy, Benign Neonatal / diagnosis*,  etiology*
Female
Fever / diagnosis*,  etiology
Humans
Hypoxia-Ischemia, Brain / diagnosis,  etiology
Infant, Newborn
Intracranial Hemorrhages / diagnosis,  etiology
Male
Neurologic Examination
Obstetric Labor Complications / diagnosis*,  etiology*
Pregnancy
Regression Analysis
Retrospective Studies
Statistics, Nonparametric
Grant Support
ID/Acronym/Agency:
1F31HD046408-01A1/HD/NICHD NIH HHS; F31 HD046408-01A1/HD/NICHD NIH HHS
Comments/Corrections

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